WHO Sticks Head in Sand Over High Cost of Newer AIDS Drugs

Must Act to Ensure Long-Term Quality Care for People With HIV/AIDS

From Médecins Sans Frontières

August 14, 2006

Toronto -- After nearly six years of providing antiretroviral treatment in developing countries, the international medical humanitarian organization Médecins Sans Frontières (MSF) expressed dismay at the political complacency surrounding the need to ensure that newer AIDS medicines are accessible for people living with HIV/AIDS in developing countries.

Data released by MSF at the XVI International AIDS Conference in Toronto clearly show how the high price of newer medicines is driving the cost of treatment up and threatening the sustainability of treatment programmes:

in the MSF-supported programme in Khayelitsha, South Africa, 10% of patients at 3 years and 16% at 4 years need to switch to second-line; however, second-line treatment is five times more expensive than first-line.

in Nigeria 8% of patients on treatment for 18 months need second-line, which costs over seven more than first line ($US 200 vs $US 1,473); tenofovir is not available as an alternative to first therapy in case of toxicity.

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In Guatemala, a second-line regimen costs US$6500 -- 28 times more than the first-line.

The World Health Organization's latest antiretroviral treatment guidelines for resource-poor settings released at the Toronto Conference recommend newer generation ARVs for both first- and second-line therapy. Because of patent issues, many of these drugs are not available from generic manufacturers. As a result, originator companies are able to charge prohibitively high prices and are often slow to make the drugs available in developing countries.

"We applaud the fact that WHO has expanded the drug formulary to include newer drugs into their guidelines. However, no mechanism exists to make those drugs available at a country level." said Dr Alexandra Calmy of MSF's Campaign for Access to Essential Medicines. "It is the responsibility of WHO to encourage governments to use the flexibilities in the WTO TRIPS Agreement, including issuing compulsory licenses to access generic drugs. Other actors, including the Global Fund and UNAIDS must also get serious about the fact that we're facing a potentially major crisis unless they act now to bring down the cost of treatment."

Generic competition has been a major engine driving down the price of first line drugs from over $US 10,000 per patient per year to under $US 140. Today, 50% of people in the developing world on ARVs rely on generic medicines from India. However, now that countries like India have to grant patents on medicines, sources of generic medicines are at risk of drying up.

Ensuring affordability of newer medicines is the only way to ensure long-term quality care for people with HIV/AIDS in the developing world. "I would not be alive today if I could not access second-line medicines," says Ibrahim Umoru, a peer educator working for MSF in Lagos, Nigeria, who had to switch treatment in 2006 after having developed resistance to first-line. "I am in the very lucky minority. Most patients whose lives had been saved by first-line treatment will be abandoned the moment they need second-line drugs unless governments pull their heads out of the sand and start tackling this issue."

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